Phage therapy for bone and joint infections: A comprehensive exploration of challenges, dynamics, and therapeutic prospects

• Published in: Journal of global antimicrobial resistance. Vol. 39; pp. 12 - 21
• Main Authors: Peng, Jiaze, Guo, Caopei, Yang, Chengbing, Zhang, Lin, Yang, Fuyin, Huang, Xianpeng, Yu, Yang, Zhang, Tao, Peng, Jiachen
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2024; Elsevier
• Subjects: Antibiotic resistance; Biofilm; Bone and joint infections; Phage; Phage therapy; Staphylococcus aureus; Biofilm; Phage therapy; Bone and joint infections; Staphylococcus aureus; Antibiotic resistance; Phage
• ISSN: 2213-7165; 2213-7173; 2213-7173
• DOI: 10.1016/j.jgar.2024.07.007

•BJI challenges: orthopaedic infections are challenging due to antibiotic resistance and biofilms.•Phage therapy's Promise: it's a non-antibiotic solution with unique abilities to combat infection challenges effectively.•Gram-negative focus: phage therapy is emerging as a strategy against antibiotic-resistant Gram-negative infections in orthopaedics.•Efficacy and challenges: bacteriophages are promising against infections, yet challenges like a narrow host range underscore the need for standardization and collaboration in orthopaedic treatments. Bone and joint infections (BJI) pose formidable challenges in orthopaedics due to antibiotic resistance and the complexities of biofilm, complicating treatment. This comprehensive exploration addresses the intricate challenges posed by BJI and highlights the significant role of phage therapy as a non-antibiotic strategy. BJI, which encompass prosthetic joint infections, osteomyelitis, and purulent arthritis, are exacerbated by biofilm formation on bone and implant surfaces, hindering treatment efficacy. Gram-negative bacterial infections, characterized by elevated antibiotic resistance, further contribute to the clinical challenge. Amidst this therapeutic challenge, phage therapy emerges as a potential strategy, showing unique characteristics such as strict host specificity and biofilm disruption capabilities. The review unveils the dynamics of phages, including their origins, lifecycle outcomes, and genomic characteristics. Animal studies, in vitro investigations, and clinical research provide compelling evidence of the efficacy of phages in treating Staphylococcus aureus infections, particularly in osteomyelitis cases. Phage lysins exhibit biofilm-disrupting capabilities, offering a meaningful method for addressing BJI. Recent statistical analyses reveal high clinical relief rates and a favourable safety profile for phage therapy. Despite its promise, phage therapy encounters limitations, including a narrow host range and potential immunogenicity. The comprehensive analysis navigates these challenges and charts the future of phage therapy, emphasizing standardization, pharmacokinetics, and global collaboration. Anticipated strides in phage engineering and combination therapy hold promise for combating antibiotic-resistant BJI.